Provider Demographics
NPI:1255329041
Name:LITTLE SISTERS OF THE POOR HOME FOR THE AGED
Entity Type:Organization
Organization Name:LITTLE SISTERS OF THE POOR HOME FOR THE AGED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SR. MARY
Authorized Official - Middle Name:SYLVIA
Authorized Official - Last Name:KARL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-464-1222
Mailing Address - Street 1:4291 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6103
Mailing Address - Country:US
Mailing Address - Phone:216-464-1222
Mailing Address - Fax:
Practice Address - Street 1:4291 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-6103
Practice Address - Country:US
Practice Address - Phone:216-464-1222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1303N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0125966Medicaid
OH366318Medicare Oscar/Certification